191: Pediatric Pain Management: the Emergency Medicine Residents' Perspectives

Abstract

Pain is a component of up to 80% of all emergency department (ED) visits. Oligoanalgesia, the under-treatment of pain, is a recognized problem in the ED and can have numerous detrimental effects for the pediatric patient. Surveying emergency medicine residents, our primary objectives were to describe a) the extent and type of training received in pediatric acute pain management, b) their management approach to common painful pediatric presentations, c) their level of comfort in assessing and treating acute pain, d) their perceived facilitators and barriers to optimally managing pain, and e) their attitudes towards managing such pain in the ED. A descriptive, cross-sectional survey was administered to all Royal College Emergency Medicine (EM) and Pediatric Emergency Medicine (PEM) residents, the Canadian College of Family Physician's EM residents, Clinical Fellows and PEM Fellows at three Canadian universities. A novel survey tool was created and distributed from May to June 2013. Surveys were completed online, using a modified Dillman approach. Our response rate was 46% (56 of 122). Forty-five percent (25 of 55) of residents had not received any training for pediatric pain assessment. All years of residents were uncomfortable with the assessment of pain in 0- to 2-year-olds (P=0.07). For patients aged two to 12 years, level of comfort with pain assessment increased with years of training (P=0.02). When assessing pain in children with disabilities, 83% (45 of 54) of residents were ‘extremely’ or ‘somewhat’ uncomfortable; 65% (47 of 55) of residents had not received any training on how to assess pain for such patients. Sixty-nine percent (38 of 55) of residents had received training on how to treat pediatric pain. All residents were more comfortable using pain medication for a nine-year-old, as compared to a one-year-old (oral oxycodone P=0.00003, oral morphine P=0.00002, IV morphine P=0.004). Ninety-eight percent (54 of 55) of residents felt that it was ‘extremely’ or ‘somewhat’ important to receive education about pediatric pain management. Their preferred methods to learn children's pain management were through role modeling (61%) and lectures (57%). Top challenges to optimal pediatric pain management were non-verbal patients, patients with disabilities, and young infants. Pediatric pain management education is important to EM residents. Residents recall receiving sub-optimal training on this important topic. They are especially uneasy in the management of younger children and those with disabilities. This study's findings can be used to inform post-graduate curriculum planning, in order to optimize pediatric pain assessment and treatment education.